Military Medicine最新文献

Background: The experiences of women veterans who served in combat and combat-support roles deserve much attention. The study aims to explore the differences in symptoms of post-traumatic stress disorder between women combatants and women in combat support roles.

Materials and methods: This cross-sectional study included the files of 71 veterans' women (mean age 25.81 [SD = 5.243; Median = 24.50]), who served over 20 years, and who filled out questionnaires on admission for evaluation. The outcome variables included 2 measures of post-traumatic stress disorder (PTSD) [PTSD Checklist for DSM-5 (PCL-5) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)], the predictors included the Dissociative Experience Scale, and the Brief Symptom Inventory.

Results: Of 49 who filled out the PCL, 77.6% (n = 38) met the criteria for probable PTSD probable PTSD (PCL ≥ 33); Of 45 who filled out the DES, 17.8% (n = 8)-met the criteria for probable dissociation (DES ≥ 30%); and of 41who filled out the BSI, 78.0% (n = 32)-found with probable distress (BSI ≥ 63). Dissociative symptoms (P = .007) were the only variable where women in combat duties differed from women in combat support roles. In women who reported experiencing combat trauma, whether they were physically injured or not, and regardless of being in a combat or in a combat-support role, the presence of probable PTSD is most strongly associated with probable distress, as measured by the BSI.

Conclusions: These findings clarify the unique needs women veterans face in receiving mental health care, of both combatants and women in combat support roles.

Objective: For traumatic injuries, prehospital ultrasound by medics impacts triage and management early in the clinical course; however, the limited availability of ultrasound experts may be a barrier to application across forward aid stations. This study aimed to assess medics' Focused Assessment with Sonography in Trauma (FAST) performance after hands-on training by an ultrasound expert versus a peer instructor.

Materials and methods: This was a single-blind, randomized controlled noninferiority study completed with ultrasound novice U.S. Army combat medics. After training by an expert or peer, participants performed a FAST. The primary outcome compared image quality scores using a 24-point Task Specific Checklist (TSC). Secondary outcomes included an objective skills assessment with a 40-point Global Rating Scale (GRS), exam duration, and self-confidence scores.

Results: Thirty-two medics received training and performed a FAST. Investigators performed a one-tailed t-test for non-inferiority, demonstrating image quality scores among peer-trained medics were non-inferior to those trained by experts (18.25 vs. 18.31; one-sided 95% confidence interval [CI], -3.08; P = .002). Investigators found no significant difference in the GRS scores (29.69 vs. 26.75; 95% CI, -2.75 to 0.08; P = .20) or exam duration (306.86 seconds vs. 279.64 seconds; 95% CI, -1.97 to 0.86; P = .75). The pre and post participation confidence survey scores also demonstrated no difference between the 2 groups.

Conclusions: The image quality of peer-trained medics performing the FAST exam was non-inferior to that of expert-trained medics, with no other differences observed. These findings support the feasibility of a hybrid training model that combines expert didactics with hands-on instruction led by either experts or peers, suggesting peer instruction may serve as a viable complement to expert-led training for ultrasound-novice medics.

Introduction: This study examined the retention intentions of United States service members through a biopsychosocial lens. Workplace retention is a paramount concern given the costs and implications for organizational stability and national security. This study identifies the unique variation in military retention intentions explained by individual and workplace characteristics and examines differences among men and women.

Materials and methods: The study uses secondary data from 1,760 service members who completed surveys at 2 timepoints (i.e., 3 months apart). Structural equation models were employed to analyze the relationships among individual characteristics (i.e., physical and mental health) and workplace characteristics (i.e., unit cohesion and military life satisfaction) in relation to their military retention intentions 3 months later. A model invariance test was used to determine if path coefficients differed by sex.

Results: The model demonstrated good fit with the data. For men and women, unit cohesion was positively and directly associated with retention intentions. For men and women, unit cohesion and mental health were associated with military life satisfaction. Men's military life satisfaction mediated the associations among their mental health, unit cohesion, and retention intentions. Women's military life satisfaction was not associated with retention intentions.

Conclusions: The study offers a holistic perspective on characteristics associated with service members' retention intentions. Mental health, unit cohesion, and military life satisfaction emerged as meaningful in understanding retention intentions of service members with some differences for men and women. Actionable insights for leadership are provided to reduce turnover and improve quality of life.

Introduction: Atrial fibrillation (AF) in military members can impair military readiness and increase military care system burdens. Atrial fibrillation clinical care quality measures have not been assessed in military populations and facilities. This study aims to assess the AF management of United States active duty military service members according to guideline clinical quality measures.

Materials and methods: Ambulatory active duty personnel with AF diagnoses between 2004 and 2019 were analyzed in reference to the published AF clinical performance measures.

Results: Three hundred eighty-six service members with AF were identified and analyzed. Nine of 11 outpatient clinical performance and quality measures were evaluated. Only 41% of encounters reported CHA2DS2-VASc scores with an increase in reporting to 64% for the more recent years 2014-2019. Nineteen of 22 (86%) personnel with indications for long-term anticoagulation received appropriate medical therapy. One hundred percent of 115 patients treated with warfarin were appropriately monitored with monthly INRs. Two patients with LVEF <40% were appropriately prescribed beta blockers. Two of 2 personnel with mechanical prosthetic valves were prescribed appropriate anticoagulation with warfarin. Thirty-one percent were inappropriately prescribed both an antiplatelet and an anticoagulant in the absence of coronary or vascular disease. Shared decision-making discussion regarding anticoagulant therapy was documented in 82%.

Conclusions: Active duty military personnel prescribed warfarin are appropriately monitored. Quality improvement processes can improve CHA2DS2-VASc score reporting, appropriate anticoagulation prescriptions, and shared decision-making discussions for military personnel with AF to reduce military health care system burdens and better outcomes for service members.

Introduction: The transition from deployment to reintegration can present unique stressors for returning service members and at-home partners. To better understand the relationship dynamics of military couples upon homecoming, we conducted a project funded by the U.S. Army Medical Research and Materiel Command (USAMRMC) Military Operational Medicine Research Program (MOMRP) to track returning service members and at-home partners across the transition. Our goal in this article is to describe findings from the project and lessons learned about collecting data from military couples upon reunion.

Materials and methods: The research design was a dyadic, longitudinal, self-report study. We gathered online survey data from 1,110 individuals (554 men, 556 women) who were involved in a romantic relationship (554 cross-sex couples, 1 same-sex couple) once per month for 8 consecutive months beginning the first week after homecoming. We analyzed both open-ended and closed-ended responses from participants.

Results: Findings documented the types of changes returning service members and at-home partners experienced over time, including both positively-valenced and negatively-valenced changes in emotional intimacy, sexual intimacy, the amount of time spent together, and appraisals of the relationship. Other analyses tracked the trajectory of the transition and revealed an acclimation process for personal well-being but a disillusionment process for relationship well-being from month to month. A third set of results identified communication during deployment, relational uncertainty, interference from a partner, relationship satisfaction, and trust between partners as relationship dynamics that predict outcomes during the transition.

Conclusions: The results imply benefits to helping military couples avoid unrealistic expectations by educating them about the relationship changes typical of reintegration. Support for relationship well-being may be most relevant 4 to 5 weeks after homecoming. Clinical services may have success targeting interpersonal communication skills, relational uncertainty, interference from a partner, relationship satisfaction, and trust between partners. With respect to collecting data from military couples, our advice for principal investigators is to be flexible, stay persistent, and build networks.

Introduction: The longitudinal study of service members is necessary to assess the unique occupational exposures and experiences that may affect long-term health and well-being. However, certain inherent aspects of military service, such as military deployments, may make repeated follow-up survey assessments for collecting ongoing exposures, health symptoms, and health outcomes challenging. The aim of this study was to understand the impact of deployment on follow-up survey response rates across a 3-year period among eligible participants in a large contemporary military cohort.

Materials and method: Data from the Millennium Cohort Study, the largest and longest running study of service members were analyzed to examine the associations between deployment during the paper or web data collection survey cycle on likelihood of response at the first follow-up, approximately 3 years after enrollment for participants originally enrolled between 2001 and 2013.

Results: Bivariate differences suggest those who deployed during the survey cycle were slightly more likely to respond. This modest difference appeared to reverse direction after adjusting for military and demographic characteristics. Among all survey responders, those who deployed during the survey cycle were consistently more likely to complete the web rather than the paper survey than those who did not deploy.

Conclusion: Collecting longitudinal survey data among active duty, Reserve and National Guard service members in deployed settings is feasible.

Introduction: The Advanced Combat Medical Experience (ACME) Teaching Assistant (TA) program at the USU actively prepares students for leadership roles in high-stakes operational environments. By engaging in experiential learning, peer teaching, and simulation-based training, ACME TAs develop essential skills in leadership, adaptability, communication, and professional identity formation. Although researchers have highlighted the educational benefits of peer teaching, they have not fully explored its impact on the military-specific competencies of medical officers. This study addresses that gap by analyzing ACME TAs' reflections to identify key themes in their professional development.

Materials and methods: We employed a qualitative descriptive phenomenological approach to analyze self-reported reflections from 19 ACME TAs after they completed the program. Participants included 8 prior-enlisted individuals with medical training and 11 newly commissioned students without prior military medical experience. Our team conducted a thematic analysis to identify recurring insights related to leadership, communication, adaptability, and identity formation. We resolved coding discrepancies through group consensus and aligned our findings with USU's educational goals for military medical training.

Results: The reflections revealed 4 primary themes: (1) Leadership Development: TAs emphasized guiding peers, maintaining composure under stress, and fostering independence. They recognized leadership as a force multiplier in training future medics. (2) Professional Identity Formation: The experience reinforced their dual role as clinicians and operational leaders, requiring them to integrate medical expertise with mission-oriented decision-making. They identified emotional resilience and self-assurance as key aspects of their identity development. (3) Communication Skills: TAs stressed the necessity of closed-loop communication, adaptive messaging, and effective feedback to ensure clarity and enhance teamwork in high-stakes environments. (4) Adaptability in Resource-Limited Settings: Participants reflected on the ethical challenges of triaging resources in austere environments and emphasized the importance of flexible decision-making based on operational constraints.

Conclusions: The ACME TA program plays a critical role in shaping the leadership, communication, and adaptability of future military medical officers. Our findings suggest that peer-led experiential learning reinforces professional identity formation and enhances mission readiness. Future research should explore the long-term impact of the TA experience on operational performance and decision-making in deployed settings. Expanding structured peer teaching programs within military medical training may further strengthen leadership development and preparedness for complex operational environments.